procalcitonin in serum (Vidas Brahms PCT Assay)
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Reference interval
- > 0.5 ng/mL predicts bacterial vs aseptic meningitis
- > 0.1 ng/mL predicts bacterial pneumonia vs heart failure
- initiation or continuation of antibiotics is encouraged for serum procalcitonin levels > 0.25-0.5 ug/L[3]
Clinical significance
- appears to be a marker for bacterial infection
- detection of serious bacterial infections in children presenting with fever without source[6]
- not useful for determining when to start antibiotic use in ICU patients[5]
- sensitivity for sepsis upon hospital admission is 68%
- assessing bacterial vs viral meningitis[2]
- assessing bacterial pneumonia vs viral etiology of lower respiratory tract infection[3]
- assessing bacterial pneumonia vs heart failure[7]
- FDA-approved Vidas Brahms PCT Assay for guidance in starting or stopping antibiotics for community-acquired pneumonia & for stopping antibiotics in sepsis[9]
- high levels (>10 ng/mL) in patients with community- acquired pneumonia associated with need for intensive care but clinical relevance uncertain[8]
- procalcitonin in serum may help guide treatment decisions, reduce antibiotic use & improve survival in patients with lower respiratory tract infections[10]
- low serum procalcitonin may identify patients hospitalized with COPD exacerbation for which antibiotic therapy > 24 hours does not reduce readmission rates[14]
- use to guide treatment for lower respiratory tract infections does not appear to reduce antibiotic prescriptions[13]
- not recommended by the Infectious Diseases Society of America to guide initiation of antimicrobial therapy in community-acquired pneumonia[16]
- may be useful for managing antibiotic cessation in ICU patients[12]
- may be increased in lung small-cell-carcinoma
- increased in medullary thyroid carcinoma
see Algorithm for procalcitonin-guided management[4]
insufficient evidence to recommend routine adoption (NICE)
Increases
Procedure
- functional assay sensitivity of 0.06 ug/L
- assay time of < 20 minutes
Notes
- it is unclear how the assay for serum calcitonin used in the diagnosis of medullary thyroid carcinoma differs from that of serum procalcitonin
More general terms
Additional terms
- calcitonin in serum
- calcitonin; contains: katacalcin; calcitonin carboxyl-terminal peptide; CCP; PDN-21 (CALC, CALC1)
Component of
References
- ↑ Journal Watch 24(7):56, 2004 Christ-Crain M et al, Lancet 363:600, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14987884
- ↑ Jump up to: 2.0 2.1 Dubos F et al, Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis J Pediatr 2006, 149:71 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16860131
- ↑ Jump up to: 3.0 3.1 3.2 Schuetz P et al Effect of Procalcitonin-Based Guidelines vs Standard Guidelines on Antibiotic Use in Lower Respiratory Tract Infections. The ProHOSP Randomized Controlled Trial. JAMA. 2009;302(10):1059-1066. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19738090 <Internet> http://jama.ama-assn.org/cgi/content/full/302/10/1059?home
Yealy DM and Fine MJ Measurement of Serum Procalcitonin A Step Closer to Tailored Care for Respiratory Infections? JAMA. 2009;302(10):1115-1116 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19738100 <Internet> http://jama.ama-assn.org/cgi/content/short/302/10/1115?home - ↑ Jump up to: 4.0 4.1 Schuetz P et al Algorithm for procalcitonin-guided management (PDF) http://jama.ama-assn.org/cgi/data/302/10/1059/DC1/1
- ↑ Jump up to: 5.0 5.1 Layios N et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med 2012 Aug; 40:2304. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22809906
- ↑ Jump up to: 6.0 6.1 Yo CH et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: A systematic review and meta-analysis. Ann Emerg Med 2012 Nov; 60:591. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22921165
- ↑ Jump up to: 7.0 7.1 Alba GA, Truong QA, Gaggin HK et al Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea. Am J Med. 2016 Jan;129(1):96-104.e7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26169892
- ↑ Jump up to: 8.0 8.1 Self WH et al. Procalcitonin as an early marker of the need for invasive respiratory or vasopressor support in adults with community- acquired pneumonia. Chest 2016 Apr 21
- ↑ Jump up to: 9.0 9.1 FDA News Release. February 23, 2017 FDA clears test to help manage antibiotic treatment for lower respiratory tract infections and sepsis. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm543160.htm
- ↑ Jump up to: 10.0 10.1 Schuetz P, Wirz Y, Sager R et al Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. The Lancet Infectious Diseases. Oct 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29037960 <Internet> http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30592-3/fulltext
Fontela PS, Papenburg J Procalcitonin and antibiotic use: imperfect, yet effective. The Lancet Infectious Diseases. Oct 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29037959 <Internet> http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30593-5/fulltext - ↑ Schuetz P, Wirz Y, Sager R et al Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017 Oct 13;10:CD007498 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29025194
- ↑ Jump up to: 12.0 12.1 Lam SW, Bauer SR, Fowler R, Duggal A. Systematic review and meta-analysis of procalcitonin-guidance versus usual care for antimicrobial management in critically ill patients: Focus on subgroups based on antibiotic initiation, cessation, or mixed strategies. Crit Care Med 2018 Jan 2; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29293146
- ↑ Jump up to: 13.0 13.1 Huang DT, Yealy DM, Filbin MR et al Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med. May 20, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29781385 Free Article https://www.nejm.org/doi/full/10.1056/NEJMoa1802670
- ↑ Jump up to: 14.0 14.1 Bremmer DN, Moffa MA, Ma K et al. Acute exacerbations of chronic obstructive pulmonary disease with a low procalcitonin concentration: Impact of antibiotic therapy. Clin Infect Dis. 2019 Feb 15;68(5):725-730 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29982350 https://academic.oup.com/cid/article-abstract/68/5/725/5047438?redirectedFrom=fulltext
- ↑ O'Riordan F, Shiely F, Byrne S et al. An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: A feasibility study. J Antimicrob Chemother 2019 Nov 1; 74:3352 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31325313 https://academic.oup.com/jac/article/74/11/3352/5536342.
- ↑ Jump up to: 16.0 16.1 Sakoulas G Clarifying Procalcitonin's Influence on Antimicrobial Use for Respiratory Tract Infections NEJM Journal Watch. Dec 13, 2019 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
- ↑ Jump up to: 17.0 17.1 Lawandi A, Oshiro M, Warner S et al. Reliability of admission procalcitonin testing for capturing bacteremia across the sepsis spectrum: Real-world utilization and performance characteristics, 65 U.S. hospitals, 2008-2017. Crit Care Med 2023 Jul 3; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37395622 https://journals.lww.com/ccmjournal/Abstract/9900/Reliability_of_Admission_Procalcitonin_Testing_for.181.aspx